Welcome to our Forum and thanks for your detailed description.  I'll try to help.  In the years since our site has moved to this site the scientific data on risk for HIV from performing oral sex on an infected partner have evolved a bit.  While there are still no proven cases in which someone has acquired HIV from receipt of fellatio, there are a very small number of cases in which is appears that performing oral sex on an infected partner has led to acquisition of HIV/  The CDC estimates that risk for infection, if a partner has untreated HIV is less than 1 infection per 10,000 acts of oral sex (i.e. like performing oral sex once daily on an untreated, infected partner daily for more than 27 years).  There are no good data to suggest that recent tooth brushing, oral sores, dental disease, etc. meaningfully change this risk but admittedly this is probably because such infections are so rare that careful studies of this manner of HIV infection are not possible to carry out.  In the case of the event you describe, your partner said he was not infected (most people tell the truth), did not ejaculate, and wore a condom most of the time.  Thus I would suspect that your risk for infection is very, very low.  OTOH, if you wish to test, at this time if you tested with a combination HIV antigen/antibody test, and were negative, you could be confident that your current symptoms are not due to HIV- typically when symptoms are due to HIV, the test is positive, even before 6 weeks.  

I hope this information is helpful. This was a low risk exposure but I would not argue against testing at this time for you for the reassurance that it would provide.  EWH

Thank you for swift reply, but as I have paid $25 I hope it is alright that I ask a few follow-up questions and make a few clarifications

1) It is not that I feel my partner was lying about his HIV status, but as a man who presumably has sex with other men often, is there not the real risk that he contracted HIV since his claimed October check-up and hence had an undiagnosed high viral load? How does this 1/10,000 statistic - for untreated HIV - apply to a high viral load?

2) I believe the progression of my sore throat and potential tonsilitis is not a consequent of this sexual exposure, as it was prominent beforehand - you think this may be the case? You have mentioned that you would not dissuade testing at this point to get reassurance. However, in the UK, the standard HIV test at most GUM clinics (as at mine, and as I understand it) is a '4th generation test', with the health advisor and NHS website saying it gives reliable results one month after infection. If this is the case, surely it is not possible for my immune system to have produced any sign of HIV at only 9 days post exposure? As i understand it, no technology can detect HIV this early and ARS symptoms do not appear until 2-4 weeks post exposure?

3) So you do feel that the duration of oral lacking a condom - and the absence of ejaculation - is important in possible risk?

4) One thing I did not mention. After the exposure I went immediately to Accident & Emergency to request PeP. But I waited for 6 hours and was refused to be given it as apparently GUM guidelines did not say it was necessary. What is your thoughts on this? Would you have prescribed PeP for a fellatio exposure or do you agree with the decision that was made?

5) Now I am just quibbling, but you mentioned my risk was potentially 'very, very low' and then 'low'. I understand these are semantic terms, but you must understand that this does trigger my anxiety. In your professional opinion, is the risk 'very' low or potentially lower? 

6) I am unable to afford private HIV testing and thus must get the test at the 4 week mark at the GUM clinic. Do you still recommend me to test now after 9 days or wait until then? NHS 1111 nor my hospital have thus far been able to tell me if its an 'antigen/antibody' test, but I presume 4th gen tests are. 

And finally, if ARS symptoms were to present themselves in the next few weeks:
- Is ARS fever severe or can it be unnoticeable?

- I understand it is rare for ARS to occur without fever? Is this true?

I know it is not visable to diagnose via ARS symptoms, but I am curious of your opinion on the matter

1.  We have many clients who come to us worried that a recent partner may have been in the process of seroconverting to HIV and would have a high viral load.  the odds of this happening numerically however are lower than your odds of being struck by lightening. 

2.  If I got the timeline of your sore throat wrong I apologize.  Current data from the U.S. CDC suggest that while over 99% of persons who have acquired HIV tested using a 4th generation test will have positive tests but that there are a very small number (less than 1%) of persons who do not seroconvert until more than 4 weeks have passed.  

3.  it tends to diminish the intensity of any exposure which may have occurred.

4.  I believe PEP is a personal choice.  Had you asked my advice, given what you told me, like the people you saw at the GUM clinic, I would have advised against PEP as well.

5.  Sigh, this IS quibbling.  I would estimate your risk of getting HIV from the exposure you described as being less than 1 in a million.

6.   4th generation tests are antigen/antibody tests.  If you are worried about your symptoms (you may not be if I got your timeline wrong) then a negative 4th generation test at this time would prove that you did not acquire HIV.  OTOH, if you are not worried about symptoms, then you should wait until at least 4 weeks to be sure, based on test results, that you did not get HIV from the exposure you described.  

The fever of HIV is typically quite obvious, not subtle.  A high fever is part of the ARS.  

I hope this information is helpful.  EWH

Apologies for the follow up. I thought I would wait and reserve the 3rd Q until after my next test at the 4 week mark - either to confirm the negative result with you or to ask for advice regarding a positive one

But my anxiety is crippling me and here I am - waiting another 2 weeks to get to the 28 day mark is going to be a struggle, I am finding it difficult to concentrate on work/exams and I feel guilty whenever I relax, like I shouldn't be entitled to watching x or y or going out with friends because I might be HIV+

The stigma is awful surrounding HIV and I respect highly the people who live with the condition and combat it daily

Anyway, here I go for the last time

1) you said you estimate my exposure risk to be less than 1 in a million, but earlier it was 1/10,000. May I ask how you arrived statistically at the 1 in a mill mark? Is it the risk X prob of hiv+ X something else?

2) The 1/10,000 statistic provided by the CDC - do you know if this is with ejaculation in mouth or without ejaculation in mouth?

3) For an earlier exposure at 30 days prior to my neg 4th gen test, how reliable is the 30 day mark? My swollen tonsil (only one) and cough were if i recall one week after the exposure i am currently worried about and obviously 25 or so days after the one for which i was neg. Could this be ARS from protected sex on 16th february?

4) ARS timeline for symptoms varies everywhere I look. Is it possible for ARS symptoms to occur within less than 7 days after infection/exposure?

5) Can ARS present as just one swollen tonsil and a persistent cough? All my internet scouring and medhelp Q's tell me that a cough with a swollen tonsil means a viral infection not baterial which is absolutely terrifying me.

6) I have no fever (that has been noticeable to me), no rash (that I can see) and no headache (again, that has been noticeable to me. Does ARS have to have these symptoms? What is % of patients who present with/without?

7) Do you have any suggestions as how to deal with this HIV anxiety? Everytime I cough my mind goes back to it, as the cough/mild throat itch tonsil swelling has been there for just under a month now. How rare is it for ARS to last this long? Is it even possible?

8) I suffer yearly from bad allergic rhinitis (hayfever) but mever coughing due to it. I read that is is very uncommon for it cause tonsil irritation and coughing,, do you reckon this is plausible?

9) how do you work our the proabibility of my partner seroconverting as less than struck as lightning?

I understand that you will very likely respond saying that 'whatever you say it will probably just fuel my anxiety' and I understand that this is a possibility

But I would like to say the positive parts of your words have been echoing in my head and keeping me somewhat sane, and I highly highly admire your tolerance of likely a lot of the same Q's from different people. 

Tolerating it without being irritable is admirable, as the MedHelp org moderators never give me answers, delete my accounts, and are giving false information that receptive oral is zero risk

Thank you in advance for your responses,

Kind Regards

Straight to your follow-up questions:

1.  Your risk is related to the risk that your partner had HIV AND the risk of the sex act.  The risk of getting HIV from performing oral sex on him IF your partner had HIV is 1 in 10,000.  The likelihood that he had HIV, based on the fact that you believed him when he said he had been tested and negative is far less than 1%.  Thus multiplying the two together  is less (and probably far less) than 1 in a million.

2.  This is an average figure which includes ejaculation into the mouth.

3.  By 30 days the 4th generation tests will detect over 99% of recent infections.

4.  No

5.  A single swollen tonsil is not the ARS

6.  Persons with the ARS virtually always have fever, along with a combination of muscle and joint aches, sore throat, and rash.

7.  ARS Symptoms do not last a month.  I would suggest you seek professional counseling to determine the factors that underlie your unwarranted anxiety.

8. Cough is very, very unusual for the ARS

9.  Your partner reached adulthood without acquiring HIV.  Acquisition of HIV is a very rare event.  The likelihood of having your partner acquire HIV and to be seroconverting without having the ARS is extraordinarily low 

This completes this thread which will be closed.  If you return to the Forum with further anxiety-drive questions your question may be deleted without return of your funds.  EWH